分期双侧单孔胸腔镜肺减容术的临床分析

Staged Bilateral Single-port Thoracoscopic Lung Volume Reduction Surgery: A Clinical Analysis

目的评估分期双侧单孔胸腔镜肺减容术(LVRS)治疗慢性阻塞性肺气肿(COPE)的可行性及疗效。方法回顾性分析2013年1月至2014年6月东南大学附属徐州市中心医院11例双侧COPE合并肺大泡的男性患者行分期双侧单孔胸腔镜LVRS的临床资料,年龄(60.27±12.11)岁。采用腔镜切割缝合器(Endo-GIA)切除过度充气的肺大泡组织,用4-0 Prolene线连续缝合加固切缘并涂抹生物蛋白胶。比较患者术前、单侧术后3个月与双侧术后3个月的肺功能、血气分析、6分钟步行距离(6-MWD)及生活质量(SF-36量表评分)。结果无围术期死亡病例,术后胸腔引流管留置时间(9.09±1.31)d,住院时间(15.73±2.75)d。术后持续肺漏气5例次,肺部感染7例次,均治愈。单侧或双侧术后3个月肺功能、动脉血氧分压、6-MWD及生活质量均较术前改善,而单侧与双侧LVRS术后比较无差异。结论分期双侧单孔胸腔镜LVRS可改善COPE患者的近期生活质量。

Objective To investigate the feasibility and efficacy of staged bilateral single-port thoracoscopic lung volume reduction surgery（LVRS） for the patients with chronic obstructive pulmonary emphysema（COPE）.Methods We retrospectively analyzed clinical data of eleven male patients with bilateral COPE and bullae in Xuzhou Central Hospital Affiliated to Southeast University from January 2013 through June 2014. All the patients underwent staged bilateral single-port thoracoscopic LVRS with their age of 60.27±12.11 years. The hyperinflated bullae were resected using endoscopic staplers（Endo-GIA）, followed by continuous suture and biological glue for reinforcement of the margin. Besides, the pulmonary function, blood gas assay, 6-minute walk distance（6-MWD）, and life quality evaluated by short form 36 Health survey questionnaire（SF-36） were recorded before and after LVRS respectively. Results All the patients survived after surgery. Chest tube drainage time was 9.09±1.31 days. Postoperative hospital stay was 15.73±2.75 days. There were 5 patients with persistent air leakage and 7 patients with pulmonary infection who were cured finally.The pulmonary function, arterial partial pressure of oxygen（PaO2）, 6-MWD and life quality after unilateral or bilateral LVRS improved than those before surgery in postoperative 3 months. However, there was no statistical difference in outcomes between unilateral and bilateral LVRS patients. Conclusion Staged bilateral single-port thoracoscopic LVRS could improve short-term life quality of patients with COPE.